Paying for health care

by

Catalunya’s public health-care system, CatSalut, enjoys a decent enough reputation for service and facilities. Even so, a quarter of all Catalans take their illnesses elsewhere, paying for private health care out of their own pockets. The truth is, anyone who has passed long hours at a neighbourhood CAP (the Generalitat’s public Primary Health Care Centres) to receive a cursory examination, or waited many months for a routine operation, can understand the reasons for seeking out a quicker, albeit more costly, alternative to public health care.

In Barcelona, at least, the private health-care sector is robust. Indeed, almost a quarter of Spain’s 311 private clinics and hospitals are located in Catalunya, mostly in or around Barcelona. Even the king comes to the city’s CIMA clinic for his annual medical check-up. “Barcelona enjoys an excellent reputation for private healthcare,” said Jaume Tort, a doctor and director of the Barcelona Centre Mèdic (BCM), a network of private clinics in the city. “Not only the king, but lots of other people from around Spain and the rest of the world come to the city for medical treatment.”

Indeed, as an association that includes most of the city’s best private clinics, the BCM actively promotes the city’s health-care offering abroad. With the rise in health-care costs in the US, or long waiting lists for operations in the UK, more and more people are finding it both cheaper and quicker to be treated outside their own country. Some 3,000 foreigners use the BCM network yearly. “Low-cost airlines to Barcelona have certainly made coming here for treatment more accessible,” said Dr. Tort, adding that the most popular treatment for foreigners, by far, was for eye problems at the world-renowned Barraquer Centre of Ophthalmology.

Catalans who opt for private health care have, of course, also long made use of their own private clinics, and are well-aware of the prestige attached to these places. Mention to a local friend, for example, that you’re going to be operated on at the Institut Universitari Dexeus and they’ll most certainly approve and remark on what a classy place it is.

One reason for Barcelona’s strong private health-care reputation lies in the Catalan tradition of doctors creating and running private clinics themselves, according to Jaume Tort. He admitted, however, that this tradition, while responsible over the years for building the city’s reputation, has now all but ended. Indeed, all of the city’s major private clinics are now owned by companies or stockholders that have little direct, professional relationship with the clinics themselves. The director of one of these private clinics, who asked not to be named, acknowledged to Metropolitan that this trend towards company or stockholder ownership of clinics could be dangerous. He pointed to the USP Institut Universitari Dexeus which has just inaugurated a brand-new, €100 million hospital.

“It’s an enormous investment,” he said. “Eighty percent of the capital has been provided by the hedge fund, Mercapital. A hedge fund looks for profits within a relatively short time-frame, and this will undoubtedly create a lot of demand at the new hospital to be profitable. In the short term, you can cut corners and make more of a profit, but in the long run your reputation will suffer. One thing people don’t play with is their own health. Personally, I’m in favour of smaller clinics.”

Be that as it may, the trend among private clinics is, clearly, to grow in size. Along with Dexeus, another of the city’s best clinics, Quirón, is also on the verge of opening a large, new, state-of-the-art hospital. “You either renovate, or die,” said BCM’s Jaume Tort. “These new hospitals will be equipped with the best facilities.”

An informal survey among health-care professionals and local Catalans seemed to indicate that the city’s top five private clinics for general medicine are probably (in alphabetical order): Corachan, Hospital de Barcelona, Quiron, Teknon and USP Institut Universitari Dexeus. “It’s actually difficult to empirically measure something like the quality of medical treatment,” said Tort, adding that each of the city’s better clinics complied with international health-care standards and would be able to hold their own when measured against the good clinics in any other location.

Jesús Paris, a recent patient at Dexeus, said he had been treated “very well”, and that he most certainly would have had to wait much longer for the same operation had he gone through CatSalut. Like most patients at private clinics, his treatment was paid for by his private health-care insurance policy. Private health insurance, offered by such companies as Adeslas, DKV, Fiatc and Sanitas, provide either full or partial coverage of health-care costs, depending on the type of policy the client contracts. Generally, monthly fees for these policies range from €35 to €90, and can include dental care as well. Some also cover health costs outside of Spain for varying periods of time.

“Whether it’s now, or in the future, everyone gets sick and needs to see a doctor,” said Jesús Paris. “I’m 50 and have been paying this insurance policy for 10 years. But without this coverage, the operation and treatment I’ve just received would have cost me an unbelievable amount.”

While most patients at the private clinics are there because of an affiliation with their insurer, the insurance companies actually pay private clinics considerably less than a patient paying for the treatment himself. Because of the volume of business they send to a clinic, they are able to negotiate favourable rates, although the treatment given a patient is no different than for an uninsured patient who came and paid for the same treatment from his or her own pocket. Jaume Tort agreed that medical treatment does not vary according to who paid for it, but added that a patient paying the clinic directly would receive such things as a better room.

One thing Jesús Paris commented on about his stay at the Dexeus clinic was that the nurses, who were generally excellent, all wore brightly coloured stickers on their uniforms with the words ‘Long hours, terrible pay’. When interviewed, the nurses, who all asked to remain anonymous, claimed that they received considerably less money than their counterparts in public hospitals, and said they were in the midst of discussions with the hospital’s management to improve their working conditions. Such disagreements between nurses and management have also occurred at other private clinics. “We’re bound by necessity to come to an agreement,” said one clinic director, who also asked not to be identified. “It’s in all of our interests.”

BCM’s Jaume Tort emphasised again that it was difficult for a private clinic to make money. One solution, he said, would be for insurance companies to pay more to clinics. “Private health insurance companies make considerable profits. At some point, they’re going to have to pay clinics more money.”

Cost of a knee replacement:

US: €27,000

France: €10,000

India: €4,000

Barcelona: €3,000

source: BCM website (www.bcm.es)